Exploring better ways to start dialysis. Show, Train, Reassure, Educate and Assess Month [STREAM-HD]

Prof John Agar1, RN Rosemary Simmonds1, RN Richard Knight1, A/Prof Christine Somerville1

1Renal Services, University Hospital Geelong, Barwon Health, , Australia

Introduction: The induction of new patients into haemodialysis (HD) programs is often poorly managed. Despite routine pre-dialysis education programs, incomplete engagement and/or frank denial of approaching HD dependence leaves many ill-prepared as they defer their decision till their pre-dialysis clock strikes midnight. Further, despite pre-dialysis attempts to identify potential ‘home’ from ‘facility’ suited patients, many patients and families still struggle to appreciate option nuances before their actual dialysis begins. We describe a Show, Train, Reassure, Educate, and Assess Month [STREAM-HD] that we think may add value to the pre-dialysis education paradigm, and help to increase home HD uptake.

Methods and Results: All patients new to HD spend up to their first month of dialysis in a 4-6 chair education and assessment (E&A) ‘pod’ sited within an existing but purpose-expanded home training unit (HTU). Exposed to skilled HTU staff, intensive but empathetic, one-on-one E&A during dialysis permits both staff and patient to understand/assess all options and potentials. Placing the STREAM process within the HTU environment crucially allows: (1) HTU staff to identify and home-enthuse patients suitable for home HD who may otherwise slide, uncaptured for home, into facility care; (2) undifferentiated new patients the opportunity to witness and learn from the ‘can-do’ attitudes of other home trainees, or from established home patients, first hand.

Conclusion: While too early to judge our SRTEAM-HD outcomes, feedback is strongly positive. We believe the STREAM-HD approach may offer a new and better way to identify home-possible patients and to grow the home haemodialysis pool.


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